=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245686138
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUARDIAN ANGELS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2016
-----------------------------------------------------
Last Update Date | 05/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 W 11TH ST
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64105-1813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-237-8063
-----------------------------------------------------
Fax | 816-421-1769
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 W 11TH ST
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64105-1813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-237-8063
-----------------------------------------------------
Fax | 816-421-1769
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. CALVIN DON VICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-481-9775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------